2 2022 ISSUE 1 The end of 2021 was a time for great celebration at Alpha Laboratories with some exciting live events. Our teams were invited to attend two award ceremonies and from both we came away with the winners accolade. Firstly, we joined our partner ShuttlePac Ltd. at the UK Packaging Awards where their innovative, specimen transport pouch, ShuttlePouch™ received “Flexible Plastic Pack of the Year”. The judges recognised that the ShuttlePouch™ substantially reduces plastic use compared to other conventional biohazard bags. Along with other benefits such as the combined fixed absorbent material and anti-injury rounded corners, it was pronounced a “worthy winner”. To win against a list of highly regarded companies in the category was indeed an honour. You can read all about the benefits of ShuttlePouch on pages 8-9. A month later, together with the Clinical Biochemistry team from Cwm Taf Morgannwg University Health Board, we received the “Partnership with the NHS” title at the MediWales Innovation Awards. This was in recognition of the successful introduction of a quantitative Faecal Immunochemical Test (FIT) service to help identify patients with colorectal disease who need urgent referrals. Read the full story on pages 4-5. Part of the successful roll out of this service is the logistics for making sample collection and return simple and convenient for patients. This is something consultant clinical biochemists at Monklands Hospital also recognised as an important requirement for their calprotectin service during the pandemic. Discover how they have successfully outsourced faecal sample preparation direct to the patient using the BÜHLMANN CALEX collection and extraction device. See pages 6-7. Alongside these informative articles this issue also brings announcements of new products, our ongoing environmental efforts, plus the live events we will be at during 2022 - we hope to see you there! Neonatal Hyperbilirubinaemia Confident Analysis Even With Haemolysed Samples Neonatal jaundice is a common condition. In most cases, it will be caused by a transient increase in unconjugated (indirect) bilirubin, due to the immaturity of the neonatal liver and increased haem turnover. This ‘physiological’ jaundice may resolve spontaneously, but close monitoring is necessary as high concentrations of unconjugated bilirubin can present a risk of brain damage. Rapid treatment with phototherapy or exchange therapy must be implemented if threshold concentrations of total bilirubin are exceeded, as detailed in NICE Clinical Guideline CG98. Unconjugated or Conjugated Bilirubin Conjugated hyperbilirubinaemia in neonates is never physiological and always requires further investigation. The ratio of conjugated or direct bilirubin (DBIL) to total bilirubin (TBIL) can help determine if the hyperbilirubinaemia is the result of predominantly unconjugated or conjugated bilirubin and facilitate clinical interpretation. Whilst reporting a bilirubin ratio is the ideal, there are certain situations where limited sample volume does not permit analysis of both and may result in a request for DBIL only. As detailed in the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guideline “Investigation of Neonatal Conjugated Hyperbilirubinaemia”, if conjugated bilirubin level is > 25 µmol/L and/or >25% of the total bilirubin, the infant should be investigated promptly for possible underlying liver disease. Although diazo-based methods for bilirubin determination are widely used, these can be prone to negative interference from haemoglobin and, when presented with haemolysed samples there is a risk that results below the true concentration may be reported. Haemolysis High levels of haemolysis are not uncommon in neonatal samples, which can make paediatric patients particularly vulnerable when assays have significant interferences from haemoglobin.
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